RG Form 7

Page No. Page 1 of 1

ON-LINE USER ACCESS Form No. GLDD-894
CONTROL FORM (PDS) Revision No. 1
Effectivity July 12, 2023

LICENSEE / COMPANY NAME: _______________________________________________

Licensed-casino e-Games e-Bingo Instawin Poker

User Information
Family Name First Name Middle Name

Position: GEL ID No.:

Office Tel. No.: Email:

Access Rights

Administrator (for PAGCOR only) Encoder

Access Agreement (Please read before signing)

1. Access account must not be allowed to be used by unauthorized persons.
2. Password must not be inserted into email messages or other forms of electronic
communication.
3. Access level account must not be used to breach security permission level or
interruptions to the program. Security breaches include, but are not limited to:
accessing data of which the employee is not an intended recipient or logging into
the program or account that the employee is not authorized to access.
4. For security and network maintenance purposes, authorized personnel from
PAGCOR may monitor equipment, systems and network traffic at any time.
5. Any User found to have violated these policies may be subjected to disciplinary
action, which could lead to revocation of the Gaming Employment License (GEL).

Authorization
User/Compliance Officer: Authorized by:

____________________________________ ____________________________________
Signature over printed name Signature over printed name
Position: ____________________________ Position: ____________________________
(Corp. Sec./Partner/Proprietor)
Date: Date:

FOR PAGCOR USE ONLY

Confirmation
Approved access by: Enrolled by:

__________________________________ ____________________________________
Signature over printed name Signature over printed name
Date: Date: